2013年1月22日 星期二

A century of medicine in Taiwan

This (above) is a ca 100-year-old photo showing a Japanese 漢醫[Han physician] diagnosing a patient. The elderly physician, apparently making a house-call, was using a method known as 把脈 [pulse/blood vessel-reading], through which the origin of the illnesses was determined and the therapy with traditional Chinese medicine started. In rural areas of Japan, this was apparently the norm, not any different from the more authentic 漢醫s then also practicing in Taiwan. [Note: The sword in the foreground was a Doctor's Sword, a Bokuto 木刀 (wooden blade), not a Samurai sword.]

On May 29, 1895, Japan invaded Taiwan. And 3 weeks later on June 20, the first military field hospital 台灣病院Taiwan Hospital, was established in a large residential house in DaDaoChen, Taipei, staffed by 10 physicians, 9 pharmacists, and 20 nurses - all of them from Japan trained in western medicine. Limited medical training classes for the locals had also started in this hospital, marking the beginning of structured formal medical education in Taiwan. [Note: Prior to this, the Presbyterian missionaries had also trained local assistants although only through apprenticeship.]

In 1896, several hospitals, including one in Tamsui, were also built to treat patients with 鼠疫 (plague, black death). This disease, however, was not indigenous to Taiwan, most likely imported by the Japanese invading forces. Cases of cholera was also found on board of Japanese war ships. These and the cholera epidemics in latter days were transmitted into Taiwan by outside visitors. A major illness native to Taiwan (and all tropics) was the mosquito-born but-not-always-fatal malaria. To prevent these diseases from spreading, improving sanitary conditions was of course a must. In later years, the improvement would prove highly beneficial.

Hygiene issues alone, however, did not do the Japanese soldiers in when they first arrived in Taiwan, however.

The colonial gov't had claimed that in the 1895 invasion, the Japanese had suffered a loss of 164 to combats and far more, 4,642 in all, had succumbed to diseases. Whether the casualty numbers were truthful and if a deliberate mis-classification of the war-dead to imply prowess of the fighting men both issues aside, the 4,000+ deaths were actually blamed on the "unsanitary" conditions in Taiwan. This is hogwash: (1) living conditions in Japan were similar to or even worse than in Taiwan (see photos below), neither was under constant assaults by infectious diseases, and Taiwan also did not report any significant epidemics at that time, and (2) most of the death from illnesses were owing to the raging beriberi, from the lack of vitamin B1 in the Japanese soldier's ration of polished white rice (cf a previous post, here). Plus, as stated above, these soldiers were also carriers of several deadly infectious diseases. In other words, the Japanese had brought death with them, not in a scenario in which the diseases were lying in wait and ambushed the hapless soldiers as soon as they had landed in Taiwan. Epidemics do not spontaneously occur until the infectious agents are accidentally introduced into a vulnerable environment, much like that in Europe during the plague epidemic in mid-14th century. The same applied to Taiwan in 1895.

A quick comparison on the standard of living between Japan and Taiwan is in order. It should be noted that neither was in the grip of an epidemic:

[Century-old photos. Above: a small town/village near Nara in Japan with houses with straw roofs, a ditch, and unpaved roads, and below: farmers with children, in front of a shinto shrine]

And in Tamsui/Taiwan, as an example:

[Above: the 新店Hsin-dian section of Tamsui of unknown date during the Japanese rule (from http://taipics.com/taipei_danshui.php), notice the sewer, paved srteet and the telephone poles, and below: well-dressed kids in leather shoes, photo taken in front of 龍山寺Lung-Shan Temple in Tamsui in the 1920s]

The pictorial face-off above, in favor of Tamsui, may be a bit unfair in the temporal sense, albeit only slightly. In fact, in under-developed frontier territories in Japan, the living standards were far poorer than in western Taiwan. The additional difference was that the Japanese Colonial Gov't did vastly improve not only the infrastructure but had also instituted education and public health systems to make Taiwan a better place to live. While in contrast, the central gov't of Japan did not apply the same efforts to some parts of, for example, Kyushu and Hokkaido. In those early colonial days, Japanese in mainland Japan often referred to Taiwan as "鬼界の島[an island bordering the underworld]" or as the "land of poisonous snakes and malaria", they had been seriously mis-informed.

On May 1, 1899, a formal medical school 台灣總督府醫學校 began accepting students and it eventually evolved, in March, 1928, into the Affiliated Dept of Medicine of Imperial Taihoku University, i.e., the 台北帝國大學附屬醫學專門部. In April, 1936, a new university-level School of Medicine 台北帝國大學醫學部 was also formed to conform to the organization of the Imperial University system - this was the predecessor to the NTU School of Medicine today. These two schools ran in parallel until 1945 when the colonial rule ended. For some years, there were three alumni associations, finally merged in 1979 into 景福會 of today.

Improving medical education is often cited as one of the major Japanese contributions to the modernization of Taiwan. This is certainly true.

In 1895, the 漢醫s in Japan lost grounds to western medicine and receded into obscurity, only to re-surface in the 1970s owing to a renewed interest. In 1900, the Taiwan medical licensing law was enacted, and the Taiwanese 漢醫s were forced to re-train or simply went underground and risked prosecution for practicing medicine without a license. The official return of Taiwanese 漢醫s started in 1958 with the establishment of China Medical University, originally the 中國醫藥學院, in Taichung.

With Taiwan reverted to ROC rule in 1945, medical licensing became an issue principally because the Ministry of Interior in Nanjing was unfamiliar with the medical education of the Taiwanese. Indeed, the level of training did vary among the applicants trained in an era of progressing medical education inside the Japan Empire. Some were graduates of university-level medical schools, many more graduated from independent private medical colleges. The schools were located not only in Taiwan but also in Japan and former Japanese territories including Manchuria, Korea, and Southern China. Also, during the Pacific War, there were highly educated and much experienced battlefield medics, physician's associates, and immunological assistants. Most were eventually granted either a full or a limited license similar to those certified under the Japanese system. [Note: Adding to the confusion, after 1949, KMT soldiers trained to provide first-aids also petitioned for and received issuance of restricted licenses.]

Medical education in the Japanese/German mode continues to this day. Attempts to switch to the American mode have met with minimal success. Today, despite the shortcomings of the National Health Insurance, people in Taiwan enjoy high-quality healthcare unavailable in many other nations in the world.